Basic Information
| Provider Information | |||||||||
| NPI: | 1710983671 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PATH LABS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1166 NATIONAL DR STE 80 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958341978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168631496 | ||||||||
| FaxNumber: | 8774059837 | ||||||||
| Practice Location | |||||||||
| Address1: | 1166 NATIONAL DR STE 80 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958341978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168631496 | ||||||||
| FaxNumber: | 8774059837 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2005 | ||||||||
| LastUpdateDate: | 02/23/2018 | ||||||||
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| AuthorizedOfficialLastName: | KOLBECK | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO/MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9168631496 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | G78120 | CA | N | Laboratories | Clinical Medical Laboratory | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.